Kennedy Quietly Strangles the Preventive Services Task Force

Why, and what does it mean for us?

Most of the talk about the Trump Administration’s “war on science” refers to its cutting NIH grants, cancelling the development of new mRNA vaccines, and otherwise blocking research. That’ll hurt us, but not for years to decades.

The other front in this war, though, is the Trumpians’ - especially Robert Kennedy’s - rejection of knowledge that we already have. The most glaring example is RFK’s gutting of the Advisory Committee on Immunization Practices (ACIP) and his other anti-vax antics. The damage that Kennedy is causing to the U.S. Preventive Services Taskforce (USPSTF) has gotten much less attention, but it’s just as ugly.

What does the USPSTF do?

My internet feeds overflow with people hawking stuff that they promise will keep me alive and vigorous. Apple cider vinegar. Full body scans. Cancer-detection tests.

The hucksters must be catering to a huge market of people hoping for immortality. And where there’s a market, entrepreneurs will sell to it, no matter how useless or harmful the stuff they are selling.

But among the many quack remedies are some tests and treatments that truly prevent disease and extend life. So how does anyone decide which ones to use? Should we take medicine for blood pressure, sugar, or cholesterol? Take a cancer scan? Swallow mega-vitamins? Inject bleach?

That’s where USPSTF comes in. It advises doctors on which preventive tests and treatments offer more value than risk, and for whom. Its advice is based on a rigorous review of studies of these tests and treatments. In reviewing those studies, the group abides by the rules that Kennedy espouses but refuses to follow himself: gold-standard science, radical transparency, and freedom from corruption and conflicts of interest.

Doctors widely follow the USPSTF recommendations because it’s such a clean, science-driven group. Last year, Alexander Krist, a family physician and former chair of the group, told NPR that, “Probably every patient I see, I’m using about five to 20 of their guidelines to make sure that I’m keeping that person healthy.”

What’s Kennedy up to?

Last July, several press outlets reported that Kennedy planned to purge the USPSTF in the same way that he had purged the ACIP. Wary of this, a group of 104 health organizations – from the American College of Physicians to the March of Dimes – signed a letter to key Senators demanding that he keeps his hands off this “national asset.”

Maybe that letter made Kennedy hesitate, because since then he hasn’t fired any members. But instead, he’s quietly strangling the group. He’s cancelled all of the group’s meetings, and for good measure, refused to name replacements for five of 16 group members whose terms have expired.

Last month, 19 Democratic Senators called out Kennedy on this. Senator Angus King said, “That’s not benign neglect, that’s malicious neglect”.

Why?

As I’ve written before, my best guess is Kennedy’s goal is to corrupt the committee so that he can funnel money to his pals. The Affordable Care Act gave the USPSTF power by requiring that health insurance companies cover without copays the preventive services that it considers proven effective. The tests and treatments that the Task Force considers unproven, useless, or harmful can be covered by insurance, but at the discretion of the health plans, and that coverage usually involves deductibles and copays.

Today, Kennedy’s friends like Dr. Mark Hyman, his Surgeon General nominee Dr. Casey Means, and her brother Calley Means can’t bill insurance companies for the Vitamin D supplements, calcium supplements, or apolipoprotein B tests that they sell but that the USPSTF doesn’t recommend. If he could pack the panel with cronies who bless these tests and treatments, though, these grifters could bill and make more money.

Why can’t other expert groups fill the gap?

After Kennedy replaced the ACIP with anti-vaxxers and the committee voted to back off on life-saving vaccine recommendations, the American Academy of Pediatrics stepped into the gap, publishing guidelines that maintained the former vaccine schedule. So why can’t similar non-governmental expert groups replace the USPSTF for non-vaccine recommendations? New recommendations by cardiologists show exactly why.

A month ago, experts representing the American College of Cardiology and American Heart Association (ACC/AHA) released guidelines that recommended:

• Cholesterol testing for:

  • All adults starting at age 19,

  • All children between the ages of 9 and 11, and

  • Children who have close relatives with early heart disease or stroke at age two.

• Treatment with statins for adults starting at age 30 who have an estimated 10-year risk of a cardiovascular problem of 5% or more.

• Coronary artery calcium scans for people over 40 with a 10-year risk of 3% or more who are unsure if they want to take statins.

This amounts to an awful lot of testing and drugs. The coronary artery scan recommendation alone might apply to some 25 million people.

On the other hand, in its most recent guidelines, the USPSTF does not recommend cholesterol testing for children, and it recommends statins only for adults over age 40 with a 10-year cardiovascular risk of 7.5% or greater. The USPSTF’s most recent (2018) guidelines do not recommend coronary artery calcium screening, but when Kennedy canceled the panel, it was in the process of reconsidering these recommendations.

Are cholesterol tests for kids and coronary artery scans for adults now scientifically justified? Here’s the problem: I do not know. It takes more expertise and time than I have to sift through all the many complicated studies to figure that out. Practicing physicians have the same problem.

But I do know that (by my count) 12 of the 33 members of the writing committee and 17 of the 29 members of the review committee for the ACC/AHA guidelines have financial ties to biotech companies that are likely to make money from this testing and treatment. (None of the USPSTF members have these conflicts.) And I know this rule: if you’re wondering whether you need a new pair of shoes, don’t ask a shoe salesman.

The muddle about cholesterol testing, statin treatment and coronary artery scans is just one example of what we are losing from the USPSTF’s paralysis. Here’s another: the group was poised to update its recommendations on the important, complex and difficult topic of prostate cancer screening. I’d rather not die of prostate cancer, but I also don’t want my prostate surgically removed unnecessarily; about a hundred million other men probably feel the same way. I sure would like to know what the experts who are not prostate surgeons advise on screening.

Where does that leave us?

Thanks to Kennedy, dozens of other important questions on the USPTF consideration list are also languishing. Each month that the Task Force is in deep freeze our ignorance accumulates.

Our $6 trillion health care system is riddled with the profit motive. Surely we can afford to have a group of experts who are not motivated by profit guiding us on which medical services actually keep us healthy. With the USPSTF dead in the water, the war on science begins to feel like a war on us.